So what are these pitted scars? These are the remnants of severe acne. They tend to be pustular acne with cysts and these take place at the base of the hair follicle. Now, when this ruptures there’s a sudden loss of collagen, and that’s when you see that big dip. There are three main types of pitted scarring. Now the most severe one is ice pick scarring because it’s the deepest. It tends to be more narrow and it tends to be deeper. You have box scars as well, which they tend to be shallower, they’re broader, they tend to have defined edges. So for example, after chickenpox, that’s the most classic type. Then you also get rolling scars. So rolling scars take place like boxcars, but basically they have more of a sloped edge so actually the appearance of the skin is uneven texture. So those are rolling scars.
So what are your treatment options? Well, first of all, start off with epidermal exfoliation, and that’s really going to help more for any discoloration. So don’t forget, if you’ve had scarring from acne it’s likely you’re going to have some PIH, post-inflammatory hyperpigmentation. So what I would recommend, of course, is your classic 2% BHA or salicylic acid plus lactic acid. I love about 5% up to 7%, and you would do this to unclog the pore and also just to remove that top layer of skin so that you just have fresher, juicier, more clear skin coming to the surface. You want to also incorporate a vitamin A into your skincare routine so that will increase your cell turnover, which means you have younger, healthier skin coming to the surface faster, but over a longer period of time is thought to also improve your collagen production.
The other ingredient I love, love, love is your fat soluble vitamin C, so that’s your tetrahexyldecyl ascorbate because that also helps to mop up any free radicals in your dermis and also help to boost collagen, which are all things that we love because don’t forget the problem here is loss of collagen acutely in a localized area.
The other treatment that is very good for this is microneedling. I know a lot of you have asked me about microneedling and if you want, I can make you another video specifically on safe microneedling at home and which ones you want to avoid and only do in clinic. If that sounds good to you, can you write down microneedling below just so I know that that is definitely something that you want to see?
With microneedling, I would use about an 0.5 millimeter on this, just to penetrate into the dermis so that you’re causing micro-injury, but controlled micro-injury into the skin and also you are allowing the actives to penetrate. So later on, I’ll tell you my specific product suggestions and how I would do it, but microneedling is something that is going to benefit anyone with pitted scarring and it’s great for skin of color, if done correctly.
Now, when it comes to professional grade treatments, there are a couple that you can do. My favorite would probably be filler, so hyaluronic acid, and it works best in a specific area so for example, if you have ice pick scarring and it’s very localized, you’re probably going to see better results than rolling scars. So that’s something that you can think about, but also it only lasts approximately a year so that’s important to know as well.
With professional grade treatments, the one I would take care with is Fraxel laser. Fraxel laser tends to have… There are two options, ablative or non-ablative. You would never use ablative for skin of color because it can trigger the melanocytes. Non-ablative is a much better option because it keeps the surface intact. However, you still want to take care but definitely avoid the ablative Fraxel laser for skin of colour.
The other things to take care of are micro dermabrasion or mid-depth to deep peels because, again, you don’t want to trigger your melanocytes and get PIH, post-inflammatory hyperpigmentation. With us, we have to just be so careful because there’s no point of spending money and time on something that’s actually just going to make the situation worse. It’s better not to do anything at all. So those are things to take care of.
Also it’s important to avoid any ingredients that can trigger any sensitivity of the skin, the key ones being alcohol, denatured alcohol, or essential oils for exactly the same reason. You don’t want to trigger free radicals which then damage your collagen. We’re trying to do the exact opposite thing.
The step by step routine, I would start off with your CeraVe SA, your salicylic acid wash. If your issue is still oily, acne-prone skin, then move on to two nights a week I would use your lactic acid. I really like the 5% lactic acid from The Ordinary. Every night I would use Paula’s Choice antioxidant serum with an 0.5 millimeter derma roller, because what you want to do is to basically get the actives penetrated down into the dermis and there are ingredients in there, including your tetrahexyldecyl ascorbate to stimulate collagen production.
With Derma rolling you also want to take care. You’re looking at doing that maybe once a week. I wouldn’t try and overdo it, but you can apply your serum every night. You may also want to incorporate an 0.5% retinol into your skincare routine. The one that I love again is from The Ordinary. I also believe that there’s an 0.3% retinol from Paula’s Choice, which I love as well. So those are really your key actives that you want to use. I think just avoid the things that are going to damage the skin, sensitize the skin, or lead to any loss of collagen.